RU2510621C1 - Method for integrated assessment of functional state of stress stimulated body - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: there are involves a clinical electrocardiographic examination and an assessment of the autonomic regulation of the physiological functions by analysing a heart rate variability. The myocardial electrophysiological characteristics are examined by a dispersion mapping of the electrocardiogram. The cardiorespiratory system is examined according to the electrocardiogram and a pneumotachogram in a combination with conducting fixed respiration rate and longest inspiratory breatholding tests. That is followed by a psychophysiological testing involving measuring simple hand-eye reaction time with sequential signal presentation. The derived data collection is used to state the presence of one of three states, including 'physiological standard', 'adaptation mechanism tension', 'maladaptation and loss of adaptation'.

EFFECT: method enables the early detection of the signs of developing tension of the regulatory body systems and reduced functional reserve thereof.

4 cl, 3 tbl

Description

The invention relates to medicine and can be used to assess the functional state of the body under stressful effects by a comprehensive study of the cardiovascular system, respiratory system, psychophysiological status and autonomic nervous system.

In space medicine, for a comprehensive assessment of the cardiorespiratory system since 2001, the Pulse mobile device was used, which allows simultaneous recording of three physiological signals: electrocardiograms, sphygmograms, and respiratory rate [1-prototype]. Based on the results of studies with the "Pulse" device, a "Method for determining the functional reserves of the regulation of the human cardiorespiratory system" was developed [2]. As a result of further development of the Pulse instrument, the Pnevmokard complex was developed and installed on board the International Space Station since 2007, which made it possible to additionally record central hemodynamics and mechanical heart function, as well as provide various functional tests to assess the functional state cardiorespiratory system [3].

These instruments are specialized for assessing the condition of astronauts aboard space objects and cannot be used in conjunction with traditional clinical and physiological methods and devices. In traditional medicine, highly specialized devices have been widely used that allow clinically evaluating the functional state of certain organs and systems. So, the PolySpektr-12 device (Neurosoft firm, Russia, Ivanovo) is used to study the electrical and mechanical function of the heart [4]. The study of blood supply to the extremities, brain and chest is carried out using the Reospectrum-2 device (Neurosoft, Russia, Ivanovo) [4]. Assessment of the volume-velocity parameters of external respiration is carried out by examination using the Spiro-Spectrum device (Neurosoft firm, Russia, Ivanovo) [4]. Stress psychophysiological tests and changes in the electrocardiogram during their conduct are evaluated by the NP-Psychotest complex (Neurosoft firm, Russia, Ivanovo) [4].

Thus, the most significant drawback of existing methods is the impossibility of a comprehensive assessment of the functional state of the whole organism, its adaptive capabilities and functional reserves, as well as the impossibility of their use for the operational assessment of the functional state of people working in stressful conditions, for example dispatchers, operators of complex systems, pilots, drivers of motor vehicles.

The objective of this method is to create a reliable method for a comprehensive physiological examination of people working in stressful conditions, with the aim of an operational assessment of their functional state.

Achievable technical result is the determination of the functional state of the body under stressful influences due to the choice of an informative set of recorded parameters that are optimal for early detection of signs of development of tension in the body's regulatory systems and a decrease in their functional reserve.

The experience of prenosological diagnostics studying functional states on the verge of norm and pathology [5, 6] shows that the cardiovascular system and its regulatory mechanisms are most sensitive to various stressful effects. A large number of publications have shown that assessing the state of various parts of autonomic regulation based on an analysis of heart rate variability (HRV) is the most commonly used method in the study of various contingents of people working under conditions of chronic stress [7]. High informativeness of methods for the analysis of HRV under stress is also confirmed by the experience of space medicine [8]. Along with the analysis of HRV in recent years, for the early detection of stress myocardial injuries, the method of dispersive ECG mapping is used, which allows to determine the initial disturbances in metabolic and energy processes in the myocardium by microelectrics of the heart’s electric potential [9], which are not detected by standard electrocardiographic studies. Finally, it is important to assess the functional state of people working under stress is to determine the rate of psychomotor reactions as an indicator of reactivity, which plays an important role in complex stressful situations.

Thus, when choosing the parameters that provide an assessment of the functional state of the body under stressful influences, the described method fully implements a scientifically based scheme for assessing the functional state of the body, the main criteria of which are: 1) determining the level of functioning of the main body systems (in this case, cardio vascular system), 2) the degree of tension of regulatory systems and their reserves [5, 8].

Reduced reserve capacity can be detected by applying load tests to regulatory systems. Table 1 presents a list of selected research methods.

Table 1. The choice of research methods for assessing the functional state of people working in conditions of chronic stress Functional State Assessment Criteria Research methods The level of functioning of the cardiovascular system Heart Rate and Blood Pressure Electrocardiography ECG Dispersion Mapping Voltage degree of regulatory systems Heart Rate Variability Analysis Functional reserves of regulatory systems Fixed breathing rate
(6 breaths per minute)
Breath holding Psychophysiological status The rate of psychomotor reactions

All methods presented in table 1 are described in numerous literary sources and are widely used in various fields of medicine and physiology.

Fundamentally new in the proposed method for assessing the functional state of persons working under stressful conditions is the combination of the described methods into a single complex with mutually agreed assessment criteria that together make it possible to determine the adaptive capabilities of the body and the degree of stress and functional reserves of regulatory systems.

The essence of the proposed method lies in the fact that the adaptive capabilities of the body in conditions of chronic stress are determined not only by the person’s ability to adapt to environmental conditions (degree of adaptation), but also by the required functional reserves. With the same degree of adaptation, a different degree of tension of regulatory systems is needed to mobilize functional reserves.

The most successful for assessing the adaptive capabilities of the body is the principle of "traffic light", described in many publications and has been used in prenosological diagnosis [6]. It is clearly for patients (users) presents the test results in the form of signals "Green", "Yellow", "Red". These signals reflect the various functional states of the body and the corresponding degree of tension of regulatory systems and their functional reserves (see table 2).

Table 2. Using the “traffic light” principle to assess the adaptive capabilities and functional states of the body Functional states Traffic Light Signals Voltage degree Functional reserves Physiological norm GREEN Optimal level Adequate level of functional reserves Moderate stress Prenosological condition YELLOW Pronounced stress Reduced level of functional reserves Pronounced stress Overvoltage Lack of functional reserves Premorbid state Pathological condition RED Depletion of regulatory mechanisms Depletion of functional reserves

For the implementation of the proposed principle of assessing adaptive capabilities and functional states of the body using the set of research methods presented in table 1, evaluation criteria have been developed. For each method, a set of the most informative indicators was selected, which allows us to characterize and differentiate different stages of the process of adaptation of the body to chronic stress. The selection of evaluation criteria (boundaries of changes in indicators) was carried out experimentally.

The studies were carried out on bus drivers [1, 2, 3, 10, 11], civil aviation pilots [4, 5] and testers who have been in isolation for a long time [6, 7]. Based on the selected criteria, a method has been developed for assessing the functional state of people working in conditions of chronic stress (table 3). In table 3, each signal of the “traffic light” corresponds to certain values of the complex of measured indicators.

Explanations for table 3 for individual research methods and indicators

1. Measurement of heart rate and blood pressure (BP) is a standard procedure. Heart rate and blood pressure standards are well known. Pulse blood pressure (PAD) is normally in the range of 40-80 mm Hg.

2. Electrocardiography is a well-known method for detecting focal myocardial lesions and studying arrhythmias. Normally, the number of arrhythmic contractions does not exceed 4%.

3. Dispersion mapping of the ECG (ECG DC) is based on the analysis of low-amplitude fluctuations in the potentials of the heart (their dispersion).

These vibrations are associated with energy and metabolic processes at the cellular level. Violation of energy-metabolic processes is associated with an increase in fluctuations in electrical potential. These fluctuations are determined at the level of 10-15 microvolts. An integral indicator of such an analysis is the myocardium indicator as the sum of all dispersion deviations. Normally, it does not exceed 15% [9].

4. Analysis of heart rate variability (HRV).

HRV analysis is an integral method for assessing the state of the mechanisms of regulation of physiological functions in humans and animals, in particular, the general activity of mechanisms, neurohumonal regulation of the heart, and the relationship between the sympathetic and parasympathetic parts of the autonomic nervous system. The method is based on the recognition and measurement of time intervals between the R-teeth of the ECG (R-R - intervals), the construction of dynamic series of cardio intervals (cardiointervalograms) and the subsequent analysis of the resulting numerical series by various mathematical methods [7]. Usually, a 5-minute ECG record is used for analysis. We calculate the following six main indicators of HRV: SI (Stress Index) normally does not exceed 150 conv. units, SDNN - the standard deviation of the duration of the cardio intervals (RMS) is normally more than 30 milliseconds; spectral analysis indicators - high-frequency (HF), low-frequency (LF) and very low-frequency (VLF) oscillations of HRV. The power of these oscillations is determined in% of the total power. Normal: HF%> 15, LF% <40, VLF% <40. A special indicator of the activity of regulatory systems (PARS) is complex and is determined in points (10 points in total). Normally, 1-3 points are noted.

5. Functional tests with a fixed rate of respiration (FTD) and breath holding.

The pneumotachogram and the electrocardiogram are recorded. A fixed breathing rate (FTD) is set with a frequency of 6 breaths per minute (respiration period of 10 seconds - FTD-10). This frequency causes activation of the subcortical vasomotor center. An ECG is used to analyze HRV and evaluate the power of low-frequency oscillations (LF.%), Which reflect the activity of the vasomotor center. Normally, the LF% value during FTD-10 increases to 70-80%. If the breath is held in inspiration, the maximum delay time exceeds 60 seconds.

6. Measurement of the speed of psychomotor reactions.

The tester is presented with two series of 20 light signals:

a) signals of the same color for measuring the time of a simple visual motor reaction (PZMR), which normally does not exceed 280-300 milliseconds;

b) signals of two colors to determine the ability to differentiated response. The number of errors in the norm does not exceed 2-6 and after the study, blood pressure is measured. Normally, the growth of GARDEN does not exceed 10-15 mm Hg.

Table 3. A method for assessing the functional state of persons working in conditions of chronic stress Functional State Assessment Criteria Performance indicators
state of the body Research methods GREEN State of physiological norm YELLOW Tension adaptation mechanisms RED Poor adaptation and failure to adapt Cardiovascular Functional Level
that system Measurement of heart rate (bpm) and blood pressure (mmHg) Heart rate - up to 75
GARDEN up to 140
DBP up to 80
PAD 40-80 Heart rate - 76-85
GARDEN 141-170
DBP 81-100
PAD 20-40
80-120 Heart rate - above 85
GARDEN above 170
DBP above 100
PAD below 20;
above 120 Electrocardiography Norm
Arrhythmia <4% Moderate changes T, ST, QRS
Arrhythmia <6% Marked changes in T, ST, QRS
Arrhythmia> 6% ECG DK IM up to 16% MI = 16-20% IM over 20% Voltage degree of regulatory systems Heart Rate Variability Analysis SI up to 150
SDNN> 30
HF%> 15
LF% <40
VLF% <40
PARS <5 SI = 150-300
SDNN = 30-20
HF% = 6-15
LF% = 40-80
VLF% = 40-70
PARS = 5-7 SI above 300
SDNN below 20
HF% <6
LF%> 80
VLF%> 70
PARS> 7 Functional
regulatory system reserves
by FTD-10
Breath holding LF%> 70
More than 60 sec LF% = 40-70
30-60 sec LF% <40
Less than 30 sec Psychophysiolo
gical status The rate of psychomotor reactions PZMR to
280 ms
Osh - 2-6
GARDEN up to +15 PZMR = 280-350 ms
Osh - 3-6
GARDEN up to +30 PZMR> 350 ms
Osh - over 6
GARDEN over +30

A set of instruments is used, including an electrocardiograph, a blood pressure meter, a respiratory sensor (pneumotachograph), a time meter for visual-motor reactions or specially designed for studies of people working in a stressful environment, the hardware and software complex "Ekosan-2007", as well as software.

Research is carried out in three stages.

1) Registration of an electrocardiogram at rest;

2) Study of the cardiorespiratory system (tests with PDT and breath holding).

3) Conducting psychophysiological testing.

The stage of registration of the electrocardiogram provides for the receipt of three types of data:

a) conducting a traditional clinical electrocardiographic study;

b) analysis of heart rate variability to assess the state of autonomic regulation of physiological functions;

c) conducting dispersion mapping of the electrocardiogram to obtain information about the electrophysiological characteristics of the myocardium and to identify early deviations in the functional state of the heart. This stage is carried out using clothespins electrodes mounted on the lower and upper limbs.

The stage of investigation of the cardiorespiratory system includes the registration of an electrocardiogram and pneumotachogram with functional tests with PDT and with holding the breath for inhalation for the maximum possible time.

In conclusion, psychophysiological testing is carried out with the measurement of the speed of a simple visual-motor reaction with 20 consecutive presentations of the signal.

Based on the results of the studies, the following list of the most characteristic changes in chronic stress can be indicated.

1) Reduced adaptive capabilities of the body among drivers, the transition from group Z (“green”) to group K (“red”) is naturally accompanied by well-known signs of an increase in the degree of tension of regulatory systems and a decrease in functional reserves: an increase in emergency and SI, a decrease in activity indicators parasympathetic system (SDNN, HF%).

New here is a distinct increase in VLF%. This can be interpreted as gradually more and more active inclusion of suprasegmental levels of control in the processes of vegetative regulation (Baevsky P.M., Berseneva A.P., Bersenev E.Yu., Eshmanova A.K., 2009).

2) Constant production stress causes not only a decrease in the adaptive capacity of the body, but also local changes in the myocardium. Using the method of dispersive ECG mapping, it was found that as the transition from 3 to K increases, the degree of exchange-energy and ischemic changes in the heart muscle, which do not appear on the electrocardiogram, but carry the risk of developing heart diseases. These changes reach a maximum in group G (“yellow”) with overstrain of regulatory systems, which, apparently, reflects the close relationship between overstrain of regulatory mechanisms and the development of local, not yet manifested electrocardiographic disturbances in energy and metabolic processes in the myocardium.

3) It was established that in individuals in groups G and K the reserve capacity of the oxygen transport link “lungs - blood” was significantly reduced, which manifests itself in a decrease in the time of holding the breath.

4) In groups G and K, a relative decrease in the power of the spectrum of low-frequency fluctuations in heart rhythm (LF) is observed during the test with a fixed breathing rate (FTD10), which may indicate a decrease in the functional reserve of the vasomotor center.

5) Tests with a simple visual-motor reaction have shown that as the adaptive capacity of the body decreases with the transition from group 3 to group K, the reaction time increases. This means that changes in the system of regulation of physiological functions due to chronic stressful effects adversely affect the psychophysiological characteristics.

6) When examining pilots of civil aviation, a significant decrease in the SDNN values is revealed in persons deemed unfit for continued flight work [12];

7) In the study of testers in conditions of prolonged isolation by the end of an 8-month stay in a pressure chamber, a significant increase in the activity of suprasegmental nerve centers that regulate energy metabolism and metabolism is detected [13].

The method is as follows

A complex of studies is carried out, consisting of:

1) registration of an electrocardiogram,

2) studies of the cardiorespiratory system with functional tests with photodynamic therapy and with breath-holding on inspiration for the maximum possible time,

3) conducting psychophysiological testing.

Each obtained value of the measured indicators is compared with regulatory data (for example, data from table 3). Then, using the principle of the maximum number of signs corresponding to a certain group, one of the three functional states of the organism is established:

1) the state of the physiological norm (symbol GREEN group),

2) the state of stress of adaptation mechanisms (symbol - YELLOW group),

3) the state of unsatisfactory adaptation or failure of adaptation (symbol - RED group).

For example, there is some combination of research data. The data obtained are compared with the information from table 3. The total number of signs is taken as 100%. Then the probability of any of the states is expressed in%, respectively, according to the number of signs of this state, determined by table 3.

Example: З = 10% (there are only 2 signs of group З);

Ж = 70% (there are 14 signs of group Ж);

K = 20% (there are 4 signs of group K).

The data obtained allow us to conclude that the subject has a state of tension of adaptation mechanisms. Examples.

CONCLUSION

Study No._ Date of examination: 12.11.2_

Name, sire: Dv. Date of birth: 01/26/1981. Position: Driver

Blood pressure and heart rate measurements indicators GARDEN DBP State of emergency GARDEN DBP State of emergency values 130 67 64 124 77 60 norm up to 140 up to 90 up to 75 up to 150 up to 100 up to 85 degree of deviation 0 0 0 0 0 0 The level of functioning of the circulatory system is normal The results of measurements of the state of the autonomic regulation system and the indicator "Myocardium" indicators pNN50 SI TR Hf Vlf arrhythmias Myocardium values 25,2 68,2 2506 49 16 0 9 norm 10-30% 80-150 conventional units 800-1500 15-25% 15-30% 0-1% up to 15% degree of deviation 0 -one +1 +1 0 0 0 The level of autonomic regulation with a predominance of parasympathetic activity Functional reserve measurement results show
whether breath hold on fixed breathing rate muscle endurance inhale exhale Lf-ref Lf-ftd Difference values 1 min 2 sec 31 sec 34.85 83.37 48.52 100% (High) norm 30-60 sec 20-30 sec 15-40% LF-Ex * 2 < LFncx < 70% < degree of deviation
niya 0 0 0 0 0 0 A good level of adaptive capabilities of the body and a sufficient functional reserve. High rate of muscle endurance. Psychophysiological Test Results indicators reaction time number of errors accuracy factor Simple hand-eye motor
naya reaction values 200 ms (Average) lead: 4 0.05 (Low) norm 193-233 0-2 0-0.03 degree of deviation 0 -2 -2 Reaction of choice values 389 ms (Average) lead: 2
delays: 1
on red: 2
on green: 3 0.09 (low) norm 332-434 0-2 0-0.03 degree of deviation 0 -3 -3 Motility of the nervous processes is normal, but with a low degree of accuracy of performing both simple and complex visual-motor tasks.

Conclusion: (H) - State physiological norm

The state of the cardiovascular system is normal. The functional reserve of the cardiovascular and respiratory systems is within normal limits. Motility of the nervous processes is normal, but with a low degree of accuracy of performing both simple and complex visual-motor tasks.

CONCLUSION

Study No._ Date of examination: 07.11.2_

FULL NAME. K-s G.M. Date of birth 01/03/1950. Position Driver

Blood pressure and heart rate measurements indicators GARDEN DBP State of emergency GARDEN DBP State of emergency values 145 one hundred 99 144 one hundred 102 norm up to 140 up to 90 up to 75 up to 150 up to 100 up to 85 degree of deviation +1 +1 +1 0 0 +1 Moderate increase in blood pressure (DBP), tachycardia The results of measurements of the state of the autonomic regulation system and the indicator "Myocardium" indicators pNN50 SI TR Hf Vlf arrhythmias Myocardium values 1.68 557.47 309.35 7 19 0.55 21 norm 10-30% 80-150 conventional units 800-1500 15-25% 15-30% 0-1% up to 15% degree of deviation -3 +3 -3 -3 0 0 +1 Overstrain of the autonomic regulation system. High heart rate stability. High stress level. Changes in metabolic processes in the myocardium of the heart Functional reserve measurement results show
bodies breath hold on fixed breathing rate muscle endurance inhale exhale Lf-ref Lf-ftd Difference more significant
niya 1 min 11 sec 27 sec 73.22 58.07 -15.15 80% (high) norm 30-60 sec 20-30 sec 15-40% LF-out * 2 < LF out < 70% < degree of deviation 0 0 +2 -3 !!! -3 !!! 0 Functional reserves of the respiratory system are sufficient. The vascular center of the circulatory system is overactive at rest. Muscular endurance is high. Psychophysiological Test Results indicators reaction time number of errors accuracy factor Simple hand-eye reaction values 242 ms (Low) lead: 1 0.01 (high) norm 193-233 0-2 0-0.03 degree of deviation -one 0 0 Reaction of choice values 486 ms (Low) advances:
delays: 1
on red: 2
on green: 1 0.05 (average) norm 332-434 0-2 0-0.03 degree of deviation -3 -one -one The mobility of the nervous processes is low, with an average degree of accuracy in completing complex tasks.

Conclusion: (G) - The state of tension of adaptation mechanisms Moderately expressed arterial hypertension with a violation of the autonomic regulation of the vascular center. Increased stress level, mild tachycardia. The functional reserves of the body are slightly reduced. The level of mobility of nervous processes is low, with average accuracy of complex visual-motor tasks.

CONCLUSION

Study No._ Date of examination: 12.11.2_

Name, surname N.M. Date of birth: 05.22.1950. Position: Driver

Blood pressure and heart rate measurements indicators GARDEN DBP State of emergency GARDEN DBP State of emergency values 141 95 89 147 92 80 norm up to 140 up to 90 up to 75 up to 150 up to 100 up to 85 degree of deviation +1 +1 +1 0 0 0 Moderate increase in blood pressure The results of measurements of the state of the autonomic regulation system and the indicator "Myocardium" indicators pNN50 SI TR Hf Vlf arrhythmias Myocardium values 0.00 1063 125.2 23 16 0.00 19 norm 10-30% 80-150 conventional units 800-1500 15-25% 15-30% 0-1% up to 15% degree of deviation -3 +3 !!! -3 !!! 0 0 0 +2 Disruption of adaptation mechanisms. Moderate changes in metabolic processes in the myocardium. Functional reserve measurement results show
bodies breath hold on fixed breathing rate muscle endurance inhale exhale Lf-ref Lf-ftd Difference values 26 sec 17 sec 59.79 88.29 28.50 99% (High) norm 30-60 sec 20-30 sec 15-40% LF-out * 2 < LF out < 70% < degree of deviation
niya -one -one +1 -3 -3 0 The functional reserves of the cardiovascular and respiratory systems are low. Muscular endurance is good. Psychophysiological Test Results indicators reaction time number of errors accuracy factor Simple hand-eye reaction values 246 ms (Low) lead: 2 0.02 (Medium) norm 193-233 0-2 0-0.03 degree of deviation -one 0 0 Reaction of choice values 347 ms (Average) lead: 3
delays:
on red: 6
on green: 3 0.14 (low) norm 332-404 0-2 0-0.03 degree of deviation 0 -3 -3 The mobility of nervous processes is low, with low accuracy in performing simple and complex visual-motor tasks. A large number of errors per primary color.

Conclusion: (K) - State of unsatisfactory adaptation or failure of adaptation

Disruption of adaptation mechanisms. The stress level is much higher than normal. High rhythm stability, moderate increase in blood pressure at rest. Changes in metabolic processes in the myocardium. The functional reserves of the cardiovascular and respiratory systems are low. The mobility of nervous processes is low, with low accuracy in performing simple and complex visual-motor tasks. A large number of errors per primary color. Care should be taken when performing professional activities.

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Claims (4)

1. The method of complex assessment of the functional state of the body under stressful impacts, including conducting clinical electrocardiographic studies, characterized in that it additionally assesses the state of the autonomic regulation of physiological functions by analyzing heart rate variability; examine the electrophysiological characteristics of the myocardium based on the dispersion mapping of the electrocardiogram; conduct a study of the cardiorespiratory system according to the electrocardiogram and pneumotachogram with functional tests with a fixed breathing rate and breath holding on inspiration for the maximum possible time, as well as psychophysiological testing with measurement of the speed of a simple visual-motor reaction with successive presentations of the signal; preliminary, the values of each measured indicator are divided into three gradations - physiological norm, prenosological or premorbid state, pathological condition; after obtaining the individual values of the measured parameters, each value is assigned to one of three states - “the state of the physiological norm”, the value of the indicator corresponds to the physiological norm, “the tension of the adaptation mechanisms”, the value corresponds to the prenosological or premorbid state, “poor adaptation and failure of adaptation”, the value corresponds to pathological condition; then, using the principle of the maximum number of indicators corresponding to one of the three conditions, the functional state of the organism is evaluated. 2. The method according to claim 1, characterized in that when examining the cardiorespiratory system, the heart rate, systolic blood pressure, diastolic blood pressure, pulse blood pressure are taken into account. 3. The method according to claim 1, characterized in that in the analysis of heart rate variability data, values of such indicators as SI, SDNN, HF%, LF%, VLF%, PARS are taken into account. 4. The method according to claim 1, characterized in that when analyzing an electrocardiographic study, the presence of focal myocardial lesions and the number of arrhythmic contractions are taken into account.